News
Tweens and teens double use of diabetes drugs over three years
5 November 2008
America's tweens and teens more than doubled their use of type 2
diabetes medications between 2002 and 2005, with girls between 10 and 14
years of age showing a 166% increase. One likely cause is thought to be
obesity, which is closely associated with type 2 diabetes.
The finding is included in a study of chronic medication use in
children ages 5 to 19 published in the journal Pediatrics by
researchers from the Saint Louis University School of Medicine, US pharmacy
benefit manager Express Scripts and the Kansas Health Institute.
In addition to diabetes, the study found that utilisation patterns
for blood pressure, cholesterol, attention-deficit disorder and
attention-deficit/hyperactivity disorder (ADD/ADHD), asthma and
depression medications increased at varying levels during the four-year
period.
"Our study findings indicate that these increased levels of chronic
medication use are symptoms of broader underlying issues affecting
children today," said Emily R. Cox, Ph.D., RPh, senior director of
research at Express Scripts. "These trends are worrisome given that many
of these therapies are treating conditions with modifiable risk factors
and if not addressed, many of these children will carry these chronic
conditions into adulthood."
For example, the use of asthma medications increased 46.5% and
ADD/ADHD medication use increased 40.4%. Cholesterol and blood pressure
medications saw a more moderate growth of 15% and 1.8%, respectively.
Except for asthma medication, older teens age 15-19 years old account
for the largest percentage of children taking these medications.
The bad news, according to Donna R. Halloran, MD, MSPH, assistant
professor of pediatrics at Saint Louis University School of Medicine, is
that there is more disease, due in large part to the increasing
prevalence of childhood obesity.
"Our findings show that childhood obesity not only has long-term
health implications, but also impacts children's immediate health,"
Halloran said.
However, she says, the rise of prescription use also indicates that
more children are being diagnosed and doctors are increasingly using
medication to treat these conditions.
"Our findings indicate that we, the doctors, are doing a better job
of screening children and diagnosing chronic conditions," Halloran said.
"A great example of this is blood pressure, where there has been a big
push to identify and treat children in need."
In several cases, the rates of growth were dramatically higher among
girls than boys. While boys still take more medications for chronic
conditions, the gap has become narrower due to these increases.
The huge increase in type 2 diabetes medication use was driven
largely by girls who saw a 147% increase over the four-year period,
compared to boys who saw a 39% increase in medicine use. Researchers say
they cannot explain this pattern, which is not consistent with the
patterns of obesity among boys and girls. However, increased physician
office visits and therefore screening rates — particularly for females —
could be one contributing factor.
Researchers say the greater increase of girls prescribed ADD/ADHD
medication (63% versus 33%) may be attributed to increased efforts by
physicians to identify ADHD in females following studies that suggested
that inattentive ADHD, which is much less likely to be identified and
treated, was more common in girls than boys.
Another example of a higher increase among females was seen in
antidepressants where the number of females between 15 and 19 taking the
medicine increased by 6.8%, while for males in the same age group,
utilization declined slightly. This increase in antidepressant use among
older teen girls was a striking exception to decreases for boys and
girls ages 5 to 9 and boys ages 10 to 14. It also occurred despite a
public health advisory released by the US Food and Drug Administration
in October 2003 regarding antidepressant use by children. Among all
children, the prevalence of antidepressant use had been increasing prior
to the advisory, after which it decreased.
Unlike the other medications studied, children ages 5 to 9 accounted
for the largest increase in the use of asthma controller medication
among the three age groups at 67.3% as compared to 38.8% for the 10 to
14 age group and 34.7% for the 15 to 19 age group.
The researchers noted that this exception could be explained by
concerns over the long-term side effects of these medications in
children and/or greater physician office visits, and therefore greater
likelihood of prescribing.
The database used in conducting the study consists of ambulatory
administrative pharmacy claims and eligibility information for over 3.5
million commercially insured children enrolled with Express Scripts
between 2002 and 2005.
The study is available at
http://pediatrics.aappublications.org/cgi/reprint/122/5/e1053
|